The Path to Universal Health Coverage
By Hannah Nie
In 2015, the United Nations General Assembly proposed the target of achieving universal health coverage by 2030 as part of the United Nations Sustainable Development Goals. In September of 2019, all 193 Member States reaffirmed their commitment to this goal in a political declaration on universal health coverage. There has been progress towards universal health coverage, but with ten years left until 2030, current efforts must be accelerated to bring the concept of universal health coverage into reality by the required timeline. The NAMUN 2020 assembly of the World Health Organization is set to debate the topic of achieving universal health cover- age and will tackle issues such as details of its implementation and financial feasibility.
According to target 3.8 of the UN Sustainable Development Goals, universal health coverage is focused on providing “financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all” (World Health Organization, “SDG 3”). Universal health coverage aims to provide quality healthcare for all without incurring financial hardships, but it does not necessarily include coverage for all potential health- care services. This brings up questions about the criteria that a medical condition should meet to warrant coverage under universal care. What constitutes “essential health services”, and how can the funding for these services be made financially sustainable, especially in developing countries with limited resources?
Effective healthcare systems will be crucial to the transition towards universal health coverage. Around the world, existing health care systems involve different proportions of government versus out-of- pocket spending, and vary in their quality, accessibility, health outcomes, and cost-effectiveness. For instance, about 70 percent of healthcare costs in Canada are covered by the government, while health services are largely provided by the private sector. In France, public health insurance is mandatory and covers 70 to 80 percent of healthcare costs, with the remaining costs often covered by voluntary health insurance. Coverage is provided for a wide range of services, and the costs of these services and other health resources are government-regulated. The pros and cons of these health insurance systems should be considered in efforts to implement universal health coverage.
Beyond the finances of universal health coverage, other aspects of the healthcare system, such as investment in primary care, the health workforce, and health technologies also affect the system's effectiveness. Primary health care, for instance, is an approach to health care which places less emphasis on the treatment of specific diseases and instead strives to provide comprehensive care for people’s overall health throughout the course of their lives. This includes protective, preventative, rehabilitative measures that help improve overall health and wellbeing. According to the World Health Organization, investment in primary care is “the most efficient and cost-effective way to achieve universal health coverage around the world” (WHO, “Universal Health Coverage”).
It is clear that many complex factors must be taken into consideration to advance health care and make universal health coverage a reality. International recognition of the importance of universal health coverage and political commitment to its implementation are steps in the right direction. In addition to the United Nations’ political declaration on universal health coverage, a resolution on universal health coverage was adopted at the Inter-Parliamentary Assembly in Serbia last year, supported by representatives from 140 countries (Ghebreyesus and Abe). Egypt, South Africa and the Philippines have passed laws mandating the implementation of universal coverage, and new initiatives in Kenya and India aim to expand free health coverage to millions of people (Ghebreyesus and Abe). Universal health coverage is a major topic of discussion internationally: recently, in late January, the Universal Health Coverage Forum in Bangkok brought together public health experts and policymakers worldwide to discuss concrete actions to take towards universal health coverage, and the Tokyo Nutrition for Growth Summit, to be held this December, will be another opportunity to discuss and consolidate plans towards universal health coverage (WHO, “From Political Commitment to Concrete Reality”).
However, in terms of actual implementation, there is still a long way to go. According to the World Health Organization, at least half of the world’s population currently lack full coverage of essential health services, and approximately 100 million people live in extreme poverty - 1.90 USD or less a day - due to the costs of healthcare (WHO, “Universal Health Coverage”). Furthermore, out-of-pocket healthcare expenses are still high and can cause excessive financial stress, with more than 930 million people spending 10% or more of their household budgets on healthcare (WHO, “Universal Health Coverage”).
The implementation of universal health coverage is an issue of increasing importance and urgency as we face challenges that will only exacerbate existing inequity. Climate change can have significant impacts on the social and environmental determinants of health, with disproportionate effects on vulnerable groups. Rapid urbanization may result in insufficient health infrastructures, and the increased population density could increase the risk of the spreading of infectious diseases, as seen in the West African Ebola virus epidemic as well as the ongoing outbreak of the COVID-19 coronavirus in China. Recent increases in the frequency of noninfectious diseases also indicate a need for more advanced care which is currently not encapsulated in traditional approaches of treating infectious diseases. Yet another challenge is the growing threat of antimicrobial resistance. Moving forward, universal health coverage and robust healthcare systems will be crucial to supporting the health and wellbeing of all humankind.
Works Cited:
“From Political Commitment to Concrete Reality: Moving Ahead on UHC in 2020.” World Health Organization, World Health Organization, www.who.int/news-room/detail/17-01-2020-from-political-commitment-to-concrete-reality-moving-ahead-on-uhc-in-2020.
Ghebreyesus, Tedros Adhanom, and Shinzo Abe. “All Nations Should Have Universal Health Care.” The Washington Post, WP Company, 12 Dec. 2019, www.washingtonpost.com/opinions/global-opinions/all-nations-should-have-universal-health-care/2019/12/12/9594269¢c-1047-11ea-8d585ac3600967a1_story.html.
“SDG 3: Ensure Healthy Lives and Promote Wellbeing for All at All Ages.” World Health Organization, World Health Organization, 3 Feb. 2017, www.who.int/sdg/targets/en/.
“Universal Health Coverage (UHC).” World Health Organization, World Health Organization, www.who.int/news-room /fact-sheets/detail /universal-health-coverage-(uhe)